Duke employees can choose from three dental options that offer different levels of coverage and different ways of choosing a dentist.
All three plans cover some or all of the cost of:
- preventive procedures such as exams and cleaning,
- basic services such as fillings, sealants, denture repair and removal of teeth, and
- major services such as crowns, dentures and root canals.
With Plan A and Plan B, you may visit any licensed dentist. Both plans include deductibles that must be met before coverage begins for non-preventive procedures.
The PPO plan includes a higher maximum annual benefit than Plan A and Plan B, and lower negotiated procedure rates. However, participants in the PPO plan must use an in-network provider. A list of in-network dentists is available at ameritas-dental.prismisp.com.
If you do not plan to use an in-network provider, you should not enroll in the PPO plan. Fee schedules for all three plans are available on the Ameritas website at ameritasgroup.com/group/olbc/duke.
How to Increase Your Annual Maximum Benefit
Dental plan members having had at least one covered dental service in the prior calendar year and having less than $500 in claims payments will have their annual maximum benefit increased by $250 in the following year.
The Benefit Threshold is $500. Dental benefits received for the year cannot exceed this threshold amount. The Annual Carryover Amount is $250 plus an additional $100 if the member visits a network provider. The maximum possible accumulation for Dental Rewards is $1000. This Dental Rewards benefit is in addition to the Annual Maximum of the members chosen plan.
Late Entrant Restrictions on Benefits for 2018
If you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2018, you or the dependent will be considered a "late entrant."
As a "late entrant" your benefits during the first twelve months of coverage will be limited to preventive services: two preventive routine care exams (not including X-rays), two prophylaxis (routine) cleanings, and for children under age 19, one fluoride application. No other dental or Orthodonita procedure or services will be covered during the first 12 months, if a member is enrolled as a late entrant.
Periodontal procedures including maintenance would not be covered during this 12 month period. Once you have been enrolled in a Duke dental insurance plan for at least 12 months, the insurance will also cover basic and major procedures such as fillings, extractions, crowns, root canals and periodontal treatment (including periodontal maintenance which apply toward cleaning frequency).
This 12-month waiting period does not apply:
- if you are switching from one Duke dental plan to another Duke plan
- if you enroll a child within 30 days of his/her second birthday
- if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption.